How Minimally Invasive Surgery Is Changing Esophageal Cancer Treatment

We spoke with Dr. Costas Bizekis, a thoracic surgeon of NYU Langone Health specializing in esophageal cancer treatment, about how minimally invasive and robotic-assisted surgery are transforming patient care. With experience spanning traditional open procedures and advanced robotic techniques, he shared insights into recovery, safety and who may be eligible for these approaches.

Cure: What Should Patients Expect From Minimally Invasive or Robotic-Assisted Esophageal Surgery Compared With Open Surgery?

Dr. Bizekis: Patients undergoing minimally invasive or robotic-assisted esophageal surgery can expect a significantly smoother recovery compared with traditional open procedures. Advances in technology have improved visualization and instrument control, allowing surgeons to perform highly precise operations while minimizing trauma to the body.

Compared with open surgery, patients typically experience less pain and recover more quickly. Hospital stays have shortened considerably — from about 10 to 12 days with traditional surgery to approximately four days with robotic approaches. Patients are also able to return to daily activities sooner, with strong overall outcomes and improved quality of life following surgery.

How Do Minimally Invasive and Robotic Approaches Affect the Risk of Complications?

Minimally invasive and robotic-assisted techniques have significantly reduced the risk of complications associated with esophageal cancer surgery. Traditional open surgery requires large incisions in both the chest and abdomen, which can lead to substantial pain, difficulty breathing or coughing, and a higher risk of complications such as pneumonia and bleeding.

With newer approaches, surgeons can perform the same complex procedures through smaller incisions while maintaining or even improving surgical precision. One major complication in esophageal surgery is an anastomotic leak, which occurs when the connection between the stomach and esophagus does not heal properly. Historically, leak rates and related mortality were high.

However, improved visualization and advanced instrumentation now allow surgeons to better assess tissue and perform more precise reconstructions. These advancements have led to markedly lower complication rates, with some centers reporting no leaks in recent consecutive cases. Overall, reduced trauma, less pain and enhanced surgical accuracy contribute to safer procedures and faster recoveries.

Are All Patients With Esophageal Cancer Eligible for Minimally Invasive Surgery?

Not all patients with esophageal cancer will ultimately undergo surgery, as eligibility depends on the specifics of their diagnosis. However, among those who are candidates for surgery, most can undergo minimally invasive or robotic-assisted procedures.

Eligibility is less about patient limitations and more about surgical expertise and experience. In many specialized centers, robotic surgery is routinely performed for all appropriate esophageal cancer cases. Even patients with a history of prior chest or abdominal surgeries can often still undergo minimally invasive procedures.

In rare cases, extensive prior surgeries or complex anatomical challenges may limit safe access to the surgical area. Still, these situations are uncommon, and the majority of patients who qualify for surgery are able to benefit from minimally invasive approaches.